# Salivary gland stone (sialolithiasis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Anatomy, Head and Neck, Submandibular Gland - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK542272/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD66.03 - condition scope only, no dose · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Acute Sialadenitis - StatPearls - NCBI Bookshelf - disease-level clinical article (acute-sialadenitis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin. - Verified date: 2026-08 ## Verified against - Salivary gland stone (sialolithiasis) - disease-level clinical article (sialolithiasis-clinical.txt) - MSF Essential Drugs 2024 (ibuprofen oral monograph) - Acute Sialadenitis - StatPearls - NCBI Bookshelf - disease-level clinical article (acute-sialadenitis-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) - Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin. ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Cephalexin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text SALIVARY GLAND STONE (SIALOLITHIASIS) Sources: Anatomy, Head and Neck, Submandibular Gland - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK542272/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD66.03 - condition scope only, no dose · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Acute Sialadenitis - StatPearls - NCBI Bookshelf - disease-level clinical article (acute-sialadenitis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin. Review status: REVIEWED against Salivary gland stone (sialolithiasis) - disease-level clinical article (sialolithiasis-clinical.txt), MSF Essential Drugs 2024 (ibuprofen oral monograph), Acute Sialadenitis - StatPearls - NCBI Bookshelf - disease-level clinical article (acute-sialadenitis- full.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219), Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin. (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (1) - Swelling on one side of a salivary gland, felt as a neck lump, with sudden pain that gets worse while eating is the usual complaint [neck lump] SIGNS - what you find (3) - The affected gland looks swollen compared to the other side on exam - A large stone may be visible in the mouth as an oval or round white-to-yellow object - A stone that is not visible can often still be felt along the path of the duct or gland TESTS (7) - Plain occlusal X-rays catch large stones but miss small ones, and only about 8 in 10 stones show up on X-ray at all - Injecting contrast into the duct for X-ray imaging is the traditional gold-standard test, though it carries radiation and contrast-reaction risk - A non-contrast CT scan detects calcified stones well and quickly, but shows the duct system poorly - Adding IV contrast to the CT gives a better look at the ducts and soft tissue with less overall radiation - MRI of the salivary ducts avoids radiation and contrast but is slower, costlier, and less available - Direct scope viewing of the duct gives an accurate diagnosis and can remove the stone at the same time - On ultrasound a stone looks like a bright spot with a shadow behind it, and detection is best for stones over 2 to 3 mm IF NOT THIS - what else fits (5) - Gland inflammation or infection without a stone can look the same as sialolithiasis - A tumor of the salivary gland is on the differential for gland swelling - Skin and soft-tissue infection of the face can mimic gland swelling - Dental decay leading to an abscess can present with similar facial swelling - Shingles affecting the face is included among conditions that can resemble this presentation Source StatPearls "Sialolithiasis" - disease-level clinical article Status traced to the source above Rx: Pain | Antibiotic - only if the gland is infected | Main treatment PAIN 1. IBUPROFEN [1st line] Adult 200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - While the gland is painful and swelling with meals, alongside hydration, massage and sialogogues. Peds 5-10 mg/kg/dose [child max 400 mg] (Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source MSF Essential Drugs 2024 (ibuprofen oral monograph) Why Conservative management is the cornerstone of a salivary stone, and both articles put a non-steroidal anti-inflammatory drug in it: the stone article's conservative measures are gland massage, NSAIDs and sialogogues, and the sialadenitis article says NSAIDs are the appropriate analgesic and help decrease the inflammation. Neither names a drug or an amount, so the amount is MSF's. Caution The pain that does not answer to it is a sign, not a dosing problem. The sialadenitis article says a patient in severe pain may require an opioid, and names no opioid and no amount, so none is printed. The medicine does not move the stone. A mobile submandibular stone under 5 mm in the distal duct, one over 5 mm, or an impacted one, each has its own procedure and needs ENT or maxillofacial referral. Anticholinergic medicines dry the saliva and work against the treatment; the sialadenitis article's conservative advice is to stop them where that is possible, along with staying well hydrated, warm compresses, duct massage and tart sweets such as lemon drops to drive salivary flow. Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection. Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication. Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure. It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid ANTIBIOTIC - ONLY IF THE GLAND IS INFECTED 2. CEPHALEXIN [1st line] Adult 250 to 1,000 mg every 6 hours, or 500 mg every 12 hours, to a maximum of 4 g a day. - The formulary sets no duration for a salivary gland infection. The sialadenitis article puts an uncomplicated case at 10 to 14 days of therapy in total. Peds 25-50 mg/kg/day [child max 2000 mg] (Child: 25 to 50 mg/kg a day for a mild to moderate infection, divided every 6 or 12 hours, to a maximum of 2,000 mg a day. The formulary's higher band of 75 to 100 mg/kg a day is for severe infection such as bone and joint infection, and is not what a salivary stone with a secondary infection calls for.) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin. Why A blocked salivary duct can infect behind the stone, and the stone article makes cervical adenopathy, purulent discharge from the duct, or erythema around the duct the trigger for antibiotic therapy without naming an agent. The sialadenitis article names the agents for exactly that situation, and cephalexin is the one of the two that Egypt stocks. Caution Only when the gland is genuinely infected. The article's signs are cervical adenopathy, pus coming from the duct, or redness around the duct opening; without them the stone is treated with hydration, massage, sialogogues and an analgesic alone. Dicloxacillin, the alternative the sialadenitis article names alongside cephalexin, has no product on the Egyptian register, so cephalexin is the workable one of the pair here. Do not give it to anyone hypersensitive to cephalexin, to another cephalosporin, or to any component of the product. Facial swelling with fever or pus points to suppurative infection, which the sialadenitis article treats as an inpatient problem needing intravenous antibiotics because of the risk of spread into the deep tissues of the head and neck. Tablets and the oral suspension are not bioequivalent, so do not swap one for the other milligram for milligram. Egypt CEFLODIX 500 MG 12 CAPS. ARAB CAPS > P... 9.00 EGP (0.75/unit) CEPHALEXCID 500 MG 12 CAPS. CID 10.30 EGP (0.86/unit) CEPHOXIN 500MG 12 TAB. PHARCO B 10.50 EGP (0.88/unit) CEPHALEXIN 500MG 10 CAPS. ARAB DRUG COM... 10.10 EGP (1.01/unit) MEDICEFLEXIN 500 MG 20 CAPS. T3A PHARMA > ... 25.25 EGP (1.26/unit) CEPHALEXIN 500MG 12 CAPS B.P.2007 SHIFA MEDICAL PRODUCTS > O... 27.00 EGP (2.25/unit) KEFLEX 500 MG 12 CAPS. HIKMA PHARMA 58.00 EGP (4.83/unit) CEPOREX 500MG 12 TABS. GLAXO SMITHKLINE 69.00 EGP (5.75/unit) AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult A calcified stone blocking a salivary duct (usually submandibular) causes painful swelling that worsens with eating. GP advises hydration, sialogogues (e.g. sour sweets), gland massage, and analgesia; gives antibiotics if the gland is infected; refers to ENT/maxillofacial for stone removal if it does not resolve. - Refer, with advice Peds A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age. Source No dose - referral pathway, no medicine given in primary care Why A calcified stone blocking a salivary duct (usually submandibular) causes painful swelling that worsens with eating. GP advises hydration, sialogogues (e.g. sour sweets), gland massage, and analgesia; gives antibiotics if the gland is infected; refers to ENT/maxillofacial for stone removal if it does not resolve. Caution The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral. RED FLAG - THE SIGNS THAT MEAN THE GLAND IS INFECTED AND NEEDS AN ANTIBIOTIC: enlarged neck nodes, pus coming from the duct opening, and redness of the skin around the duct. A stone alone does not need an antibiotic; a stone with these does. RED FLAG - Complications of chronic untreated obstruction include permanent gland fibrosis and atrophy. RED FLAG - Facial swelling with fever or pus, suggesting suppurative sialadenitis, signs of abscess, or recurrent stones. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)